ITCHING IN ACNE - AN UNUSUAL COMPLICATION OF THERAPY

Pruritus at the site of active acne has not been described before as a complication of acne therapy. We report 8 cases seen over a 3-year pe riod at our department with localized itching mainly at the active acn e sites, within 2-6 weeks of starting effective acne therapy. Seven ha d oral tetracyclines (oxytetracycline, Vibramycin or Minocin) with or without topical antibiotics or benzoyl peroxide. Only 1 patient receiv ed oral isotretinoin. The severity of itch was mild to moderate in mos t cases with the severest reaction in the isotretinoin-treated patient . All cases resolved within 4 weeks, 7 with non-sedative antihistamine therapy (terfenadine), and 1 resolved spontaneously upon cessation of antibiotic therapy. The pathogenesis of this localized itch is presum ed to be related to the change in pH of the micro-environment of the a cne follicle providing an optimal environment for the production of hi stamine or histamine-like products by Propionibacterium acnes. This re port highlights the self-limiting nature of pruritus during effective anti-acne therapy. Increased awareness of this uncommon complication h elps prevent the unnecessary discontinuation of effective acne therapy .